2015 Summary of APAPO GR Activities, and a Look Ahead to 2016

From repealing and replacing Medicare’s sustainable growth rate to Congress’ taking a serious look at improving federal mental health funding, 2015 was a busy year for the APA Practice Organization Government Relations Office and our grassroots network. Here are some of the highlights from 2015, and our priorities for 2016.

Repeal of the Medicare Sustainable Growth Rate

In April, Congress overwhelmingly passed the Medicare Access and CHIP Reauthorization Act (MACRA) MACRA to repeal the flawed-Medicare Sustainable Growth Rate and replaced it with a Medicare payment system based on rewarding quality and value. In so doing, a 21% cut in Medicare payment was averted. In the month leading up to this vote, psychologists from around the country sent more than 13,000 letters to their members of Congress and visited more than 350 congressional offices during the 2015 State Leadership Conference.

MACRA established an incentive payment program called the Merit-Based Incentive Payment System (MIPS) which transitions the three existing incentive programs (the Physician Quality Reporting System, Value-Based Modifier, and Meaningful Use of electronic health records) into one consolidated program. Medicare physicians and certain primary care providers are eligible in 2019 for MIPS, and other health professionals will be added in 2021.

Additionally, APAPO submitted a comment letter on November 13, 2015 to the Centers for Medicare & Medicaid Services in response tothe agency’s Request for Informationregarding changes in payment involving MIPS and alternative payment models. For more information, read FAQs on MACRA and its impact on psychologists in APAPO’s Spring/Summer 2015 issue of Good Practice Magazine.

The Medicare Mental Health Access Act (H.R. 4277)

In December, Rep. Kristi Noem, a Republican from South Dakota, joined by Rep. Jan Schakowsky, a Democrat from Illinois, introduced H.R. 4277, the Medicare Mental Health Access Act, in the U.S. House of Representatives. This bipartisan legislation would allow psychologists to provide Medicare services to their patients without unnecessary physician supervision in all treatment centers by amending the Medicare definition of physician to include psychologists.

Reps. Noem and Schakowsky are members of the influential House Ways & Means Committee and House Energy & Commerce Committee, respectively. These committees have jurisdiction over health care legislation. APAPO is solidifying sponsors to introduce a companion bill in the U.S. Senate and more information will be forthcoming soon.

Helping Families in Mental Health Crisis Act of 2015 (H.R. 2646)

Introduced in June by Rep. Tim Murphy (R-PA), a psychologist, and Rep. Eddie Bernice Johnson (D-TX), a psychiatric nurse, H.R. 2646 focuses on reforming programs and providing needed resources for individuals with serious mental illness and their families.

There are many notable provisions in this legislation that would benefit practicing psychologists and their patients, including ensuring full compliance and enforcement of the Mental Health Parity and Addiction Equity Act of 2008. Additionally, the bill reauthorizes vital programs, such as the Garrett Lee Smith Memorial Act, the National Child Traumatic Stress Network, the Minority Fellowship Program and the National Suicide Prevention Lifeline program. H.R. 2646 also expands authority for mental health services financed by Medicaid and eliminates the long-standing discriminatory 190-day lifetime limit in Medicare for psychiatric hospital services.

Your Practice Organization has worked closely with the bill sponsors and members of the House Energy & Commerce Committee to pass this vital legislation, and with the help of over 1100 psychologists writing letters into their members of Congress, this legislation passed out of the Energy & Commerce’s Health Subcommittee. We expect the full Energy & Commerce Committee to take up this legislation in early 2016.

Mental Health Reform Act of 2015 (S. 1945)

In August Senators Bill Cassidy (R-LA) a physician, and Sen. Chris Murphy (D-CT), introduced S. 1945, which is similar to H.R. 2646, and focuses on creating a mental health system which efficiently and effectively offers patients, providers, families and caregivers access to timely and quality care. APAPO has worked closely with the legislative sponsors to provide input and feedback on the legislative language. Practice Organization members have also been writing their Senators to ask for their support.

Important provisions of the bill include promoting integration between mental and physical health care and expanding workforce development opportunities for mental health professionals, including reauthorization of the minority fellowship program and the Behavioral Health Education and Training Grant programs, which includes Graduate Psychology Education (GPE) programs. The Senate Health, Education, Labor and Pension Committee held several hearings on the Mental Health Reform and another one is schedule for January 2016.

Mental Health Awareness and Improvement Act of 2015 (S. 1893)

Another APAPO supported bill with strong psychology grassroots support, the Mental Health Awareness and Improvement Act, passed in the U.S. Senate in December. This bill, introduced by Sen. Lamar Alexander (R-TN), Chairman of the Health, Education, Labor and Pensions Committee and Sen. Patty Murray (D-WA), Ranking Member of the Committee, reauthorizes and improves current programs that focus on suicide prevention, mental health care for children and older adults, mental health awareness training, and the integration of mental and physical health care.

S. 1893 also reauthorizes the Garrett Lee Smith Memorial Act and the National Child Traumatic Stress Initiative along with mental health training grants to help teachers, emergency personnel, and others be trained to recognize signs of mental illness and to safely de-escalate crisis situations. This legislation also calls for investigation and analysis of federal requirements that act as a barrier to the greater integration of mental and behavioral health care with primary care. APAPO expects the U.S. House of Representatives to consider this legislation in 2016.

Medicare Reimbursement Rates

The impact on Medicare-allowed charges for clinical psychologists in 2016 is estimated by CMS to be 0%, meaning, besides the mandatory sequestration cut of 2% imposed to all Medicare providers, clinical psychologists should not anticipate any additional decreases in the Medicare fee schedule. Most of the other specialties will also see no impact this year as well. The Bipartisan Budget Act of 2015, signed by President Obama on November 2nd, extended the 2% sequestration cut for Medicare providers through 2025.

Medicare payments to psychologists have declined significantly since 2001, because under the current formula, Medicare pays more for higher-cost, technology-driven services with high overhead. Your Practice Organization continues to advocate for a change in the Medicare payment formula so that psychologists are appropriately and fairly compensated for treating Medicare beneficiaries. This work will continue with the agency this year.

Medicare PQRS Registry

APAPO continues to help psychologists who report quality measures in Medicare. Psychologists who participate in Medicare will face a 2% payment penalty in 2018 unless they participate in the program’s physician quality reporting system (PQRS) in 2016. As previously reported, APAPO has teamed up with Healthmonix, a leading health care data and technology company, to offer “PQRSPRO” to mental and behavioral health professionals in individual and group practices. PQRSPRO is a web-based registry allowing psychologists and other providers to submit PQRS data with CMS more readily, including data for claims already filed in the reporting year.

Psychologists wishing to use the PQRSPRO registry for the 2015 reporting year have until January 31, 2016 to enroll. The registry is accessible online at http://apapo.pqrspro.com, and providers can register at the site for a flat rate of $199 per reporting year. Using the registry will greatly increase psychologists’ chances of successfully participating in PQRS, while reducing their risk of future reductions in payment due to PQRS penalties.

Consolidated Appropriations Act

The Consolidated Appropriations Act, also referred to as the 2016 Omnibus Budget Bill, passed Congress on December 18, 2015. The spending package included increased funding for a program long supported by APAPO, and new funds for a program targeted for people with serious mental illness.

Specifically, The Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA) programs received $10 Million, a $2.5 million increase from 2015. Originally authorized by Congress in 2004 and administered by U.S. Department of Justice, the program works with states and communities to improve outcomes for individuals with mental illness who are involved in the criminal justice system. Additionally, the Omnibus budget bill fully funded an Assisted Outpatient Treatment (AOT) Pilot Program at $15 Million. Authorized in 2014 for three years, but not funded until now, this pilot program is administered by the U.S. Department of Health and Human Services and provides up to 50 grants per year for local jurisdictions to implement court ordered psychiatric community based treatment for individuals with serious mental illness and who meet certain criteria.

Looking ahead to 2016...

Even with a shortened legislative calendar due to the Presidential election year, 2016 is shaping up to be a busy year. Your Practice Organizations’ goals for 2016 include: adding psychologists to the Medicare physician definition; increasing psychologists’ Medicare payment rates under the physician fee schedule; and passing comprehensive mental health care reform.

In closing, let me thank you for all your hard work. APAPO could not advocate without you, and we in the APAPO government relations office are grateful for your assistance and dedication. For questions or comments, contact APAPO Government Relations Office at pracgovt@apa.org or 202-336-5889. Happy 2016!